First Nations Communities In Canada Research Articles

24 - Implementation and Evaluation of a Diabetes Registry in First Nations Communities in Canada: Data From the FORGE AHEAD Study

Diabetes registries can identify epidemiologic trends, care gaps, inform health policy and are associated with better processes and outcomes of care. As part of the FORGE AHEAD, a participatory research program partnering with First Nations (FN) communities in Canada, local community data gatherers (CDGs) were hired and trained to populate the FN Diabetes Surveillance System (FNDSS) web-based diabetes registry/surveillance tool.

What’s in a Name? Impact of Community Power, Identity, and Logics on Cross-Sector Agreement Quality

Many grand challenges - climate change, poverty, and geographic dislocations – disproportionately affect disadvantaged communities. One way to address these challenges is to collaborate across sectors. In this preliminary paper, we explore the formation of one type of collaborative agreement between disadvantaged communities and other parties: Impact Benefit Agreements (IBAs) between First Nations communities in Canada and mining companies. We consider specifically the ways in which identity and institutional logics systematically combine with the relative power of the disadvantaged communities to result in various levels of agreement quality. We find that what seems to matter more than either power or logics is community identity and the degree of community subscription to that identity.

Barriers to climate change adaptation in indigenous communities: A case study on the mohawk community of Kanesatake, Canada

The switch from climate change mitigation to the adaptation to its impacts or effects initially appears to be a promising strategy. Academics and practitioners, however, confront limits and barriers to the adaptation both in theory and practice. Despite the extensive efforts in understanding limits and barriers, little is still known about political and institutional barriers, more specifically political challenges in Indigenous communities that typically nullify the effect of adaptation strategies. This study investigates the experience of the Mohawk community of Kanesatake, a First Nations community in Canada, during and after the 2017 and the 2019 floods in Quebec. Results reveal the links between the proximate set of barriers and historical, political pressures in Indigenous communities. Findings explain that unhealed wounds in relationships among nations generate political and institutional hurdles, which eventually orchestrate the co-occurrence of multiple barriers: the lack of land ownership rights, insurance, and social institutions such as police force and firefighters, to name a few. Findings have implications both for theory and practice. In theory, the findings reveal the fact that barriers are not mutually exclusive; in fact, they are often interdependent. In practice, findings support the fact that policies fail if they disregard underlying interdependencies.

Predictors of household food insecurity and relationship with obesity in First Nations communities in British Columbia, Manitoba, Alberta and Ontario.

To further understandings of household food insecurity in First Nations communities in Canada and its relationship with obesity. Analysis of a cross-sectional dataset from the First Nations Food, Nutrition and Environment Study representative of First Nations communities south of the 60th parallel. Multivariate logistic regression was used to assess associations between food insecurity and sociodemographic factors, as well as the odds of obesity among food-insecure households adjusting for sociodemographic characteristics. Western and Central Canada. First Nations peoples aged ≥19 years. Forty-six percent of First Nations households experienced food insecurity. Food insecurity was highest for respondents who received social assistance; had ≤10 years of education; were female; had children in the household; were 19-30 years old; resided in Alberta; and had no year-round road access into the community. Rates of obesity were highest for respondents residing in marginally food-insecure households (female 56·6 %; male 54·6 %). In gender-specific analyses, the odds of obesity were highest among marginally food-insecure households in comparison with food-secure households, for both female (OR 1·57) and male (OR 1·57) respondents, adjusting for sociodemographic variables. For males only, those in severely food-insecure (compared with food-secure) households had lower odds of obesity after adjusting for confounding (OR 0·56). The interrelated challenges of food insecurity and obesity in First Nations communities emphasise the need for Indigenous-led, culturally appropriate and food sovereign approaches to food security and nutrition in support of holistic wellness and prevention of chronic disease.

Social-Ecological Determinants of Access to Fish and Well-Being in Four Gwich’in Communities in Canada’s Northwest Territories

River systems globally are experiencing social-ecological changes that often impact Indigenous fishing practices, including climate change and resource developments. We explore the relationship between access to fish and well-being, and the determinants of access to fish amidst changing social-ecological conditions through interviews with 29 individuals across four Gwich’in First Nation communities in Canada’s Northwest Territories. Our interviews show that socioeconomic and environmental barriers are making it harder to access fish and that this has negative implications for well-being. Despite these barriers, access to fish continues to make positive, diverse contributions to well-being in Gwich’in communities through socioeconomic factors such as sharing networks and adaptive practices that are often part of ecological monitoring and land-based education and facilitate access to fish. Increasing our understanding of the relationship between access to fish and well-being, and determinants of access to fish, can contribute to land-based programs, land-use planning, and decision-making in Gwich’in territory and other river systems.

Explaining the variability in cardiovascular risk factors among First Nations communities in Canada: a population-based study

Historical, colonial, and racist policies continue to influence the health of Indigenous people, and they continue to have higher rates of chronic diseases and reduced life expectancy compared with non-Indigenous people. We determined factors accounting for variations in cardiovascular risk factors among First Nations communities in Canada. Men and women (n=1302) aged 18 years or older from eight First Nations communities participated in a population-based study. Questionnaires, physical measures, blood samples, MRI of preclinical vascular disease, and community audits were collected. In this cross-sectional analysis, the main outcome was the INTERHEART risk score, a measure of cardiovascular risk factor burden. A multivariable model was developed to explain the variations in INTERHEART risk score among communities. The secondary outcome was MRI-detected carotid wall volume, a measure of subclinical atherosclerosis. The mean INTERHEART risk score of all communities was 17·2 (SE 0·2), and more than 85% of individuals had a risk score in the moderate to high risk range. Subclinical atherosclerosis increased significantly across risk score categories (p<0·0001). Socioeconomic advantage (-1·4 score, 95% CI -2·5 to -0·3; p=0·01), trust between neighbours (-0·7, -1·2 to -0·3; p=0·003), higher education level (-1·9, -2·9 to -0·8, p<0·001), and higher social support (-1·1, -2·0 to -0·2; p=0·02) were independently associated with a lower INTERHEART risk score; difficulty accessing routine health care (2·2, 0·3 to 4·1, p=0·02), taking prescription medication (3·5, 2·8 to 4·3; p<0·001), and inability to afford prescription medications (1·5, 0·5 to 2·6; p=0·003) were associated with a higher INTERHEART risk score. Collectively, these factors explained 28% variation in the cardiac risk score among communities. Communities with higher socioeconomic advantage and greater trust, and individuals with higher education and social support, had a lower INTERHEART risk score. Communities with difficulty accessing health care, and individuals taking or unable to afford prescription medications, had a higher INTERHEART risk score. Cardiac risk factors are lower in communities with high socioeconomic advantage, greater trust, social support and educational opportunities, and higher where it is difficult to access health care or afford prescription medications. Strategies to optimise the protective factors and reduce barriers to health care in First Nations communities might contribute to improved health and wellbeing. Heart and Stroke Foundation of Canada, Canadian Partnership Against Cancer, Canadian Institutes for Health Research.

Investigation of the Association between Adult Wheeze and Household Beta(1→3)-glucan Exposures in First Nations Communities in Canada

TPS 752: Respiratory effects and allergies, Exhibition Hall, Ground floor, August 27, 2019, 3:00 PM - 4:30 PM Background: In Canada, damp housing conditions in First Nations communities continues to be a major concern for respiratory health. In this context, no studies have reported the role of household beta glucans. We examined the association between β(1→3)-glucans in household dust and reports of wheeze. Methods: As part of the First Nations Longitudinal Respiratory Health Study initiated in 2012, participating adults who completed a respiratory and environmental questionnaire volunteered to partake in a home environmental assessment that included collection of settled dust for β(1→3)-glucan analysis. Information was obtained about housing conditions including water leaks/floods and subsequent damage in the past 12 months, mold or mildew odor and visible signs of mold. Dust samples were collected from floors of common living areas following the International Study of Asthma and Allergy in Children (ISAAC) protocol. Prior to laboratory analysis, dust was sieved and stored at -20°C. Analysis for β(1→3)-glucan was performed using Glucatell assay according to manufacturer’s specifications. Wheeze was defined as any wheeze without colds or wheezing most days or nights. Logistic regression with generalized estimating equations were used to examine associations between wheeze and β(1→3)-glucan (log transformed) adjusting for current smoking, damp housing, mildew odor, pets, age and sex. Results: Of the 874 participants, there were 317 adults living in 144 homes who participated in the home assessments. Of these, 293 adults had valid household β(1→3)-glucan results. The prevalence of wheeze was 47.0%. The mean (standard deviation) levels of soluble β(1→3)-glucan were 33.1(22.76) pg/mL. While reports of damp housing were associated with increased wheeze (p< 0.05), higher β(1→3)-glucan levels in the home were associated with lower wheeze (p < 0.05). Conclusion: The inverse association between household beta glucans levels and wheeze found in this study adds to the controversy regarding the varying role of β(1→3)-glucans for human respiratory health.

\u201cIf you understand you cope better with it\u201d: the role of education in building palliative care capacity in four First Nations communities in Canada

BackgroundIn Canada, there is a growing need to develop community-based, culturally appropriate palliative care for Indigenous people living in First Nations communities. The public health approach to palliative care, which emphasizes community-based initiatives, is especially relevant in First Nations communities because care is grounded in their distinct social and cultural context. Central to the public health approach are educational strategies that strengthen communities’ capacity to care for their vulnerable members as they die. This paper presents community-based research conducted with First Nations communities in Canada that aimed to assess and address local palliative care educational needs to improve community capacity in palliative care.MethodsParticipatory action research (PAR) was conducted with four First Nations communities in Canada over a six-year period (2010–2016). The research occurred in three phases. Phase 1: focus groups, interviews and surveys were employed to assess community specific needs and resources. Phase 2: recommendations were developed to guide the PAR process. Phase 3: educational resources were created to address the identified educational needs. These resources were implemented incrementally over 4 years. Ongoing process evaluation was employed, and revisions were made as required.ResultsEducational needs were identified for patients, families, community members and internal and external health care providers. A wide and comprehensive range of educational resources were created to address those needs. Those culturally appropriate educational resources are available in a very accessible and useable workbook format and are available for use by other Indigenous people and communities.ConclusionsThis research provides an example of the public health approach and offers implementation strategies around palliative care education. This paper contributes to the international literature on the public health approach to palliative care by presenting a case study from Canada that includes: conducting a culturally appropriate assessment of educational needs, creating recommendations, facilitating development and implementation of educational resources in the community to improve community capacity in palliative care.

“We Don’t Drink the Water Here”: The Reproduction of Undrinkable Water for First Nations in Canada

First Nation communities in Canada are disproportionately plagued by undrinkable water and insufficient household sanitation. In addition, water resource management in First Nation communities has long been a technocratic and scientific mission controlled by state-led authorities. There has been limited engagement of First Nations in decision-making around water management and water governance. As such, problems associated with access to drinkable water and household sanitation are commonly positioned as hydrological or environmental problems (flood or drought) to be fixed by technical and engineering solutions. This apolitical reading has been criticized for not addressing the root cause of the First Nation water problem, but instead, of reproducing it. In this paper, an approach using political ecology will tease out key factors contributing to the current water problem in many First Nation communities. Using case study research set in source water protection planning, this paper explains how persistent colonial practices of the state continue to reproduce undrinkable water and insufficient household sanitation. Solutions to this ‘water problem’ require greater attention to First Nations water governance capacity and structures.

Reclaiming Indigenous Planning as a Pathway to Local Water Security

Access to drinkable water is essential to human life. The consequence of unsafe drinking water can be damaging to communities and catastrophic to human health. Today, one in five First Nation communities in Canada is on a boil water advisory, with some advisories lasting over 10 years. Factors contributing to this problem stretch back to colonial structures and institutional arrangement that reproduce woefully inadequate community drinking water systems. Notwithstanding these challenges, First Nation communities remain diligent, adaptive, and innovative in their efforts to provide drinkable water to their community members. One example is through the practice of source water protection planning. Source water is untreated water from groundwater or surface water that supplies drinking water for human consumption. Source water protection is operationalized through land and water planning activities aimed at reducing the risk of contamination from entering a public drinking water supply. Here, we introduce a source water protection planning process at Muskowekwan First Nation, Treaty 4, Saskatchewan. The planning process followed a community-based participatory approach guided by trust, respect, and reciprocity between community members and university researchers. Community members identified threats to the drinking water source followed by restorative land management actions to reduce those threats. The result of this process produced much more than a planning document but engaged multiple community members in a process of empowerment and self-determination. The process of plan-making produced many unintended results including human–land connectivity, reconnection with the water spirit, as well as the reclaiming of indigenous planning. Source water protection planning may not correct all the current water system inadequacies that exist on many First Nations, but it will empower communities to take action to protect their drinking water sources for future generations as a pathway to local water security.

Moving Towards an Indigenous Research Process: A Reflexive Approach to Empirical Work With First Nations Communities in Canada

Moving towards reconciliation within Indigenous research requires the careful examination of existing practices at all stages of the research process. Engagement in and dissemination of reflexive processes may increase the relevance of research results for Indigenous communities and partners. This article describes and contextualizes the results obtained from this qualitative research study examining parenting needs and child reunification in these communities. The initial results were deemed relevant by the partnering community but research stakeholders reported that they did not reflect all community values. Based on the advice of the Research Advisory Group, the research team decided to further analyze the results to address these shortcomings. The reanalysis process focused on improving the perceived meaningfulness and relevance to communities. Exploration of how these results were re-situated in an Indigenous framework of wellbeing is discussed. Researcher reflections about the project processes and considerations for future research are explored.

Describing the process of ethical conduct of research in an Ontario-wide First Nations diabetes research project.

KEY POINTS In recent decades, diabetes and related complications have emerged as substantial challenges in First Nations communities in Canada.[1][1] To advocate for appropriate services within a complex, and often fragmented, health system for First Nations people,[2][2],[3][3] First Nations

Epidemiological and genomic determinants of tuberculosis outbreaks in First Nations communities in Canada

BackgroundIn Canada, tuberculosis disproportionately affects foreign-born and First Nations populations. Within First Nations’ peoples, a high proportion of cases occur in association with outbreaks. Tuberculosis transmission in the context of outbreaks is thought to result from the convergence of several factors including characteristics of the cases, contacts, the environment, and the pathogen.MethodsWe examined the epidemiological and genomic determinants of two well-characterized tuberculosis outbreaks attributed to two super-spreaders among First Nations in the province of Alberta. These outbreaks were associated with two distinct DNA fingerprints (restriction fragment-length polymorphisms or RFLPs 0.0142 and 0.0728). We compared outbreak isolates with endemic isolates not spatio-temporarily linked to outbreak cases. We extracted epidemiological variables pertaining to tuberculosis cases and contacts from individual public health records and the provincial tuberculosis registry. We conducted group analyses using parametric and non-parametric statistical tests. We carried out whole-genome sequencing and bioinformatic analysis using validated protocols.ResultsWe observed differences between outbreak and endemic groups in the mean number of total and child-aged contacts and the number of contacts with new positive and converted tuberculin skin tests in all group comparisons (p < 0.05). Differences were also detected in the proportion of cases with cavitation on a chest radiograph and the mean number of close contacts in selected group comparisons (p < 0.02). A phylogenetic network analysis of whole-genome sequencing data indicated that most outbreak and endemic strains were closely related to the source case for the 0.0142 fingerprint. For the 0.0728 fingerprint, the source case haplotype was circulating among endemic cases prior to the outbreak. Genetic and temporal distances were not correlated for either RFLP 0.0142 (r2 = − 0.05) or RFLP 0.0728 (r2 = 0.09) when all isolates were analyzed.ConclusionsWe found no evidence that endemic strains acquired mutations resulting in their emergence in outbreak form. We conclude that the propagation of these outbreaks was likely driven by the combination of characteristics of the source cases, contacts, and the environment. The role of whole-genome sequencing in understanding mycobacterial evolution and in assisting public health authorities in conducting contact investigations and managing outbreaks is important and expected to grow in the future.

A mixed-method examination of risk factors in the truck-to-cistern drinking water system on the Beardy’s and Okemasis First Nation Reserve, Saskatchewan

The provision of safe drinking water is a key driver of public health and a pressing health issue facing First Nations communities in Canada. Contaminated water is a perennial issue for reserve communities across the country despite numerous government investments. Many First Nations communities rely heavily on cistern use for their drinking water supply; however, bacterial contamination within these systems is frequent and a common reason for household boil water advisories. The sources of contamination during the process of hauling water to cisterns in First Nations communities have received limited attention in academic research. The purpose of this research is to identify the risks to water quality through the truck-to-cistern water system. In partnership with a Saskatchewan First Nations community, drinking water quality was monitored in the treatment plant, in delivery trucks and at 142 household cisterns and taps from July to October, 2014. Risks to water supply were identified through monthly water sampling and laboratory analysis, key informant interviews, and observation. Coliform contamination in trucks, cisterns and taps was most common during August. Total coliforms were more likely to be found in cisterns compared to household taps and samples from trucks. Chlorine residuals were lower in household tap samples than in cisterns for August and September. Together with the community, investigators identified contamination and bacteriological growth in cisterns and household distribution systems, and variable levels of total chlorine concentrations depending on month and site of sampling. Recommendations are provided for advancing guidelines on management of truck-to-cistern drinking water supply chains in First Nations.

Exploring concussion awareness in hockey with a First Nations community in Canada.

The purpose of this pilot study was twofold: (1) to begin to understand concussion in youth hockey in a First Nations community in Canada and (2) to determine the impact of a novel concussion education workshop. A one-group quasiexperimental time series study was undertaken. A total of 41 participants consented, with 71% (n=29) completing data collection at all three study time points. Two nurses one from the First Nations community and one from the tertiary care center collaborated to develop and deliver the intervention on concussion specifically general, hockey and symptom knowledge. The primary outcome was Total Knowledge Score (TKS), whereby correct responses to a self-reported questionnaire were summed and then converted to a percentage. The TKS were similar across study time points; preworkshop 71.7%, postworkshop 71.8%, and 6-month follow-up 72%. Nurses worked collaboratively with cultural experts from a First Nations community to integrate Indigenous ways of knowing into concussion awareness and safety for First Nations youth playing hockey.

Canada’s evacuation policy for pregnant First Nations women: Resignation, resilience, and resistance

BackgroundAboriginal peoples in Canada are comprised of First Nations, Métis, and Inuit. Health care services for First Nations who live on rural and remote reserves are mostly provided by the Government of Canada through the federal department, Health Canada. One Health Canada policy, the evacuation policy, requires all First Nations women living on rural and remote reserves to leave their communities between 36 and 38 weeks gestational age and travel to urban centres to await labour and birth. Although there are a few First Nations communities in Canada that have re-established community birthing and Aboriginal midwifery is growing, most First Nations communities are still reliant on the evacuation policy for labour and birthing services. In one Canadian province, Manitoba, First Nations women are evacuated to The Pas, Thompson, or Winnipeg but most – including all women with high-risk pregnancies – go to Winnipeg. AimTo contribute scholarship that describes First Nations women’s and community members’ experiences and perspectives of Health Canada’s evacuation policy in Manitoba. MethodsApplying intersectional theory to data collected through 12 semi-structured interviews with seven women and five community members (four females, one male) in Manitoba who had experienced the evacuation policy. The data were analyzed thematically, which revealed three themes: resignation, resilience, and resistance. FindingsThe theme of resignation was epitomized by the quote, “Nobody has a choice.” The ability to withstand and endure the evacuation policy despite poor or absent communication and loneliness informed of resilience. Resistance was demonstrated by women who questioned the necessity and requirement of evacuation for labour and birth. In one instance, resistance took the form of a planned homebirth with Aboriginal registered midwives. ConclusionThere is a pressing need to improve the maternity care services that First Nations women receive when they are evacuated out of their communities, particularly when understood from the specific legal and constitutional position of First Nations women in Manitoba.

Shifting the Framework of Canadian Water Governance through Indigenous Research Methods: Acknowledging the Past with an Eye on the Future

First Nations communities in Canada are disproportionately affected by poor water quality. As one example, many communities have been living under boil water advisories for decades, but government interventions to date have had limited impact. This paper examines the importance of using Indigenous research methodologies to address current water issues affecting First Nations. The work is part of larger project applying decolonizing methodologies to Indigenous water governance. Because Indigenous epistemologies are a central component of Indigenous research methods, our analysis begins with presenting a theoretical framework for understanding Indigenous water relations. We then consider three cases of innovative Indigenous research initiatives that demonstrate how water research and policy initiatives can adopt a more Indigenous-centered approach in practice. Cases include (1) an Indigenous Community-Based Health Research Lab that follows a two-eyed seeing philosophy (Saskatchewan); (2) water policy research that uses collective knowledge sharing frameworks to facilitate respectful, non-extractive conversations among Elders and traditional knowledge holders (Ontario); and (3) a long-term community-based research initiative on decolonizing water that is practicing reciprocal learning methodologies (British Columbia, Alberta). By establishing new water governance frameworks informed by Indigenous research methods, the authors hope to promote innovative, adaptable solutions, rooted in Indigenous epistemologies.

Celebrating indigenous communities compassionate traditions.

Living in a compassionate community is not a new practice in First Nations communities; they have always recognized dying as a social experience. First Nations hold extensive traditional knowledge and have community-based practices to support the personal, familial, and community experiences surrounding end-of-life. However, western health systems were imposed and typically did not support these social and cultural practices at end of life. In fact, the different expectations of western medicine and the community related to end of life care has created stress and misunderstanding for both. One solution is for First Nations communities to develop palliative care programs so that people can receive care at home amongst their family, community and culture. Our research project "Improving End-of-Life Care in First Nations Communities" (EOLFN) was funded by the Canadian Institutes of Health Research [2010-2015] and was conducted in partnership with four First Nations communities in Canada (see www.eolfn.lakeheadu.ca). Results included a community capacity development approach to support Indigenous models of care at end-of-life. The workshop will describe the community capacity development process used to develop palliative care programs in First Nations communities. It will highlight the foundation to this approach, namely, grounding the program in community values and principles, rooted in individual, family, community and culture. Two First Nations communities will share stories about their experiences developing their own palliative care programs, which celebrated cultural capacity in their communities while enhancing medical palliative care services in a way that respected and integrated with their community cultural practices. This workshop shares the experiences of two First Nations communities who developed palliative care programs by building upon community culture, values and principles. The underlying model guiding development is shared.

First Nations wastewater treatment systems in Canada: Challenges and opportunities

The Government of Canada has prioritized the availability of water and wastewater services for the Canadian First Nations Communities (CFNC) and introduced the First Nations Water and Wastewater Ac...

The rise and fall of dental therapy in Canada: a policy analysis and assessment of equity of access to oral health care for Inuit and First Nations communities

BackgroundInequality between most Canadians and those from Inuit and First Nations communities, in terms of both access to oral health care services and related health outcomes, has been a long-standing problem. Efforts to close this equity gap led to the creation of dental therapy training programs. These programs were designed to produce graduates who would provide services in rural and northern communities. The closure of the last dental therapy program in late 2011 has ended the supply of dental therapists and governments do not appear to have any alternative solutions to the growing gap in access to oral health care services between most Canadians and those from Inuit and First Nations communities.MethodsA policy analysis of the rise and fall of the dental therapy profession in Canada was conducted using historical and policy documents. The analysis is framed within Kingdon’s agenda-setting framework and considers why dental therapy was originally pursued as an option to ensure equitable access to oral health care for Inuit and First Nations communities and why this policy has now been abandoned with the closure of Canada’s last dental therapy training school.ResultsThe closure of the last dental therapy program in Canada has the potential to further reduce access to dental care in some Inuit and First Nations communities. Overlaps between federal and provincial jurisdiction have contributed to the absence of a coordinated policy approach to address the equity gap in access to dental care which will exacerbate the inequalities in comparison to the general population. The analysis suggests that while a technically feasible policy solution is available there continues to be no politically acceptable solution and thus it remains unlikely that a window of opportunity for policy change will open any time soon.ConclusionIn the absence of federal government leadership, the most viable option forward may be incremental policy change. Provincial governments could expand the scope of practice for dental hygienists in the hope that it may support enhanced access, consumer choice, and efficiency in the delivery of oral health care to Inuit and First Nations communities in Canada.